Christine Jorm

Reconstructing Medical Practice examines how doctors see health care and their place in it, why they remain in medicine and why they are limited in their ability to lead change in the current system. Doctors are beset by doubts and feel rejected by systems where they should be leaders - some see their role as 'flog[ging] a derelict system to get the last breath of workability out ... for their patients'. Others simply turn away. Rigorous studies carried out at large public teaching hospitals in Australia found that doctors were reluctant to increase safety in the wider health system, despite making every effort for their 'own' patients. Doctors' self-esteem was found to be delicate due to the uncertain nature of their work; colleagues provide the support doctors need to deliver good care. However, these essential relationships and their cherished connections with patients have disadvantages: reducing doctors' ability to admit to error. On top of this, senior doctors predict a future bereft of professional values - one where medicine is 'just a job'. While the loss of professional identity introduces new risks for patients and doctors, the repercussions of the more self-serving attitudes of younger doctors are unknown. Reconstructing Medical Practice concludes that regulation, despite its recent proliferation, is a clumsy and limited approach to ensuring good care. It presents original and much-needed ideas for ways to rebuild the critical relationship between doctors and the system. By better valuing communicative interactions and workplace relationships, safe and satisfying medical practice can be reconstructed.